Lewy Body Dementia

Question 1

Type of dementia?

Answer 1

degenerative

Question 2

Aetiology? (2)

Answer 2

Lewy-bodies found in brain stem nuclei (esp. basal ganglia)

Neuronal loss and reduced ACh transmission

Question 3

Microscopic changes? (2)

Answer 3

AZD plaques but fewer NFTs/tau pathology

Question 4

What age does it commonly develop?

Answer 4

50-85 years

Question 5

3 core features?

Answer 5

Parkinsonism (bradykinesia, tremor, cogwheel rigidity, abnormal gait)
Fluctuating cognitive + level of consciousness
Hallucinations (visual 60%, auditory 20%)

Question 6

How many core features needed to diagnose?

Answer 6

2

Question 7

Other symptoms?

Answer 7

Depressive episodes
Recurrent falls, syncope
Sleep disorders (R.E.M.)

Question 8

Investigations?

Answer 8

Cognitive assessment (MMSE)/AMTS
Physical examination
Blood: FBC, U&E’s, glucose, calcium, LFT’s, TFT’s
Midstream urine test (rule out delirium)
CT/MRI - lewy-body in basal ganglia of brain stem, white matter lesions.
Single-photon emission computed tomography (SPECT)

Question 9

What does SPECT detect?

Answer 9

Low dopamine transporter uptake in basal ganglia

Question 10

Biological Mx?

Answer 10

ACh-i: Donezapil, Rivastigmine, Galantamine

Question 11

What can help the sleep disturbances?

Answer 11

Clonazapam (BZD)